How common is comorbidity of personality disorders in anxiety disorders?: Jl Affect dis:Feb.2013


Anxiety disorders (AD) have a lifetime prevalence of 30%. Comorbidity is the norm in anxiety disorders, some of which emerge secondary to the primary difficulties.Comorbidity of personality disorder assumes special significance as it has huge effects on quality of life and treatment  outcomes. Reviews suggest  that the comorbid frequency of PDs among patients with an AD diagnosis vary considerably, but that the proportions are highest in the avoidant, dependent and compulsive PDs (cluster C). One meta-analysis (Ng and Bornstein,2005) examined the comorbidity of dependent PD and found that panic disorder, OCD, agora and social phobia showing a higher prevalence of PDs, while GAD and PTSD showed no relationship with PDs.  No metaanalysis is available with AD as the primary inclusion criteria.

OddgeirFriborg,MonicaMartinussen,SabineKaiser,KarlToreØverga ̊rd and Jan H. Rosenvinge report the results of such a meta analysis. They included 125 studies that had AD as primary diagnosis( and provided proportion of different comorbid personality disorders).Half of the studies were conducted on outpatients.Most studies were conducted in America (62 studies) and Europe (58 studies).


The risk of having at least one comorbid PD (any PD) was high across all ADs, ranging from 35% in PTSD to 52% in OCD.Cluster C PDs (avoidant, dependent and obsessive-compulsive) were observed more than twice  (ie 39%)as often as cluster A (paranoid, schizoid, schizotypal, anti-social) (19%)  or cluster B (borderline, histrionic, narcissistic) PDs (13%).

Social phobia had the highest proportion of  an avoidant PD.  PTSD stands out as clinically more heterogeneous in nature ( different comorbidity profile with a mixture of PD comorbidity, mainly paranoid, avoidant, borderline and the OCD PD) compared with the other ADs.  OCD AD patients did not have a noticeably higher occurrence of a comorbid OCD PD (20%) compared with the other cluster C PDs, notably the avoidant PD (17%). Gender was not found to influence the comorbidity rates.


A substantial proportion of AD patients also present with an avoidant PD. Authors suggest that this should be addressed in the routine clinical assessment and treatment of AD patients. 

Summary of the article:

Comorbidity of personality disorders in anxiety disorders: A meta-analysis of 30 years of research.

Friborg O, Martinussen M, Kaiser S, Overgård KT, Rosenvinge JH. J Affect Disord. 2013 Feb 20;145(2):143-55

This paper focuses however on the proportions of comorbidity of axis II personality disorders (PD)

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